Authors: Haylie L. Miller and Nicoleta L. Bugnariu


Different levels of immersion in Virtual environments (VEs) for delivering social skills interventions to individuals with autism spectrum disorder (ASD) and the influence of this levels of immersion on the efficacy of VEs as a tool for assessing and teaching social skills.


  • To critically evaluate the level of immersion used in previous studies (low, moderate, and high immersion);
  • To highlight unanswered questions about the generalizability of skills learned in the virtual world, the level of immersion required to successfully teach social skills, and the variability in treatment response across individuals with ASD with differing symptom profiles; and
  • To propose a possible theoretical framework for examining the level of immersion used in a study.


This research groups studies into low-, moderate-, and high-immersion categories and examins them from five aspects of immersion including identifying emotions or intentions, conversation, gesturing, socially appropriate behaviours and cooperation.


Low-immersion VEs are sufficient to detect some differences in social performance. Exceptions may be due to participant characteristics, including the tendency to be immersed, attention, and symptom severity. However, the literature on intervention studies is considerably less straightforward. In one instance, low-immersion VEs produced improvement in social skills. However, while some moderate-immersion VEs have produced improvements, others have not.


The current body of work suggests that VEs may offer an appropriate avenue for delivery of social skills therapies for some individuals with ASD. The potential advantage to using VEs in place of more traditional measures or intervention approaches lies in the ability to generate more ecologically valid tasks and to teach and assess skills under conditions that more closely mimic the real world. Additional research is needed to determine whether this approach is equivalent to traditional face-to-face intervention.

Authors: Brandon Birckhead, Carine Khalil, Xiaoyu Liu, Samuel Conovitz, Albert Rizzo, Itai Danovitch, Kim Bullock, and Brennan Spiegel


Therapeutic virtual reality (VR) is an innovative and efficacious treatment modality gaining considerable attention to manage a broad range of health conditions. However, in spite of encouraging outcomes from early stage research, a consensus is needed for how best to develop and evaluate VR treatments within a scientific framework.


This research sought to develop a methodological framework with input from an international working group to guide the design, implementation, analysis, interpretation, and communication of trials that develop and test VR treatments.


A group of 21 international experts was recruited based upon contributions to the VR literature. The resulting Virtual Reality Committee of Outcomes Research Experts (VR-CORE) held iterative meetings to seek consensus regarding best practices for development and testing of VR treatments.


The interactions were transcribed, and key themes were identified to support a scientific framework to support methodology best practices for clinical VR trials. A framework emerged to support three phases of VR clinical study designs, herein named VR1, VR2, and VR3.

VR1studies focus on content development by working with patients and providers through principles of human centered design. VR2trials conduct early testing with a focus on feasibility, acceptability, tolerability and initial clinical efficacy. VR3 trials are randomized, controlled studies to evaluate efficacy versus a control condition. Best practice recommendations for each trial are provided.


Patients, providers, payers and regulators may consider this best practice framework when assessing the validity of VR treatments.

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